Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial

Henderson, Catherine ORCID: 0000-0003-4340-4702, Dixon, Simon, Bauer, Annette ORCID: 0000-0001-5156-1631, Knapp, Martin ORCID: 0000-0003-1427-0215, Morrell, C. Jane, Slade, Pauline, Walters, Stephen J. and Brugha, Traolach (2018) Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial. Psychological Medicine. ISSN 0033-2917

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Abstract

Background There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal. Methods Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12). Results In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%). Conclusions PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.

Item Type:	Article
Official URL:	https://www.cambridge.org/core/journals/psychologi...
Additional Information:	© 2018 Cambridge University Press © CC BY-NC-ND 4.0
Divisions:	Care Policy and Evaluation Centre
Subjects:	H Social Sciences > HQ The family. Marriage. Woman R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	11 Oct 2018 08:44
Last Modified:	01 Nov 2024 05:10
URI:	http://eprints.lse.ac.uk/id/eprint/90406

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